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General NPI Number Information
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NPI Number | 1043878598
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Entity Type | Organization
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Legal Business Name | LEGRANDERX PHARMACY LLC
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 05/30/2019
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Provider Practice Location Address
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Address Line | 343 E 4TH N STE 126
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City | REXBURG
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State | ID
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Zip | 83440-6004
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Country | US
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Telephone | 855-534-7263
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Fax | 208-421-9792
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Provider Business Mailing Address
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Address Line | 343 E 4TH N STE 126
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City | REXBURG
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State | ID
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Zip | 83440-6004
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Country | US
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Telephone | 855-534-7263
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Fax | 208-421-9792
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DR. CHARLENE REBECCA HOIT
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Credential | PHARMD
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Telephone | 509-953-6863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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